Medical Student University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania, United States
Introduction: Depression and anxiety affect 10-20% of all people, are leading causes of nonfatal disease, and are underdiagnosed globally. Mental health can play a significant role in surgical outcomes. Degenerative spinal conditions are ubiquitous and commonly require surgical intervention. Understanding the relationships between mental health and spinal surgery outcomes is critical for optimizing perioperative care.
Methods: Consecutive patients without a previous diagnosis of anxiety or depression and scheduled to undergo single-level lumbar fusion surgery were prospectively administered a 5-Dimension quality of life survey (EQ5D) (n=1428). One dimension stratifies risk of co-morbid depression and anxiety (EAS) (subscore of 1-3). Coarsened exact matching (CEM) was utilized to perform a 1:1 match of patients with the highest EAS to those with the lowest EAS. CEM permits strict control of, and matching on, patient characteristics known to impact outcomes. Primary outcomes included intraoperative complication, length of stay, discharge disposition, and 30- and 90-day emergency department (ED) visits, readmissions, reoperations, and mortality.
Results: After exactly matching patients with an EAS of 3 and 1, an elevated risk of anxiety and depression (EAS 3, n=85 vs EAS 1, n=85) was significantly associated with increased risk of prolonged hospital stay (p=0.0003), non-home discharge (OR 3.28, p=0.0035), 30- and 90-day readmission (OR 5.0, p= 0.0209 and OR 3.66, p=0.0325), and 90-day ED visits (OR 9.0, p =0.0114). No differences in intraoperative complication or 30- or 90-day reoperation rates were uncovered between cohorts.
Conclusion : Risk of undiagnosed depression and anxiety, measured by the EAS, is associated with greater odds of short-term postoperative healthcare utilization, but not intraoperative complication or reoperation. Further study should investigate the utility of the EAS as a tool to guide targeted risk-mitigation strategies and optimize outcomes for patients with depression and anxiety.